Trends in the incidence of work-related traumatic limb amputations in South Korea from 2004 to 2013

FHIR-standardized data collection on the clinical rehabilitation pathway of trans-femoral amputation patients

Lower limb amputation is a medical intervention which causes motor disability and may compromise quality of life. Several factors determine patients' health outcomes, including an appropriate prosthetic provision and an effective rehabilitation program, necessitating a thorough quantitative observation through different data sources. In this context, the role of interoperability becomes essential, facilitating the reuse of real-world data through the provision of structured and easily accessible databases. This study introduces a comprehensive 10-year dataset encompassing clinical features, mobility measurements, and prosthetic knees of 1006 trans-femoral amputees during 1962 hospital stays for rehabilitation. The dataset is made available in both comma-separated values (CSV) format and HL7 Fast Healthcare Interoperability Resources (FHIR)-based representation, ensuring broad utility and compatibility for researchers and healthcare practitioners. This initiative contributes to advancing community understanding of post-amputation rehabilitation and underscores the significance of interoperability in promoting seamless data sharing for meaningful insights into healthcare outcomes.

Trends in the Incidence and Etiology of Non-Traumatic Spinal Cord Injury in Korea: A Nationwide Population-Based Study From 2007 to 2020

BACKGROUND

Although patients with non-traumatic spinal cord injury (NTSCI) have distinct epidemiological characteristics compared to those with traumatic spinal cord injury, no previous study has reported the incidence of NTSCI on a national scale in Korea. In this study, we examined the trend in incidence of NTSCI in Korea and described the epidemiological characteristics of patients with NTSCI using nationwide insurance data.

METHODS

National Health Insurance Service data were reviewed for the period from 2007 to 2020. The International Classification of Diseases, 10th revision, was used to identify patients with NTSCI. Inpatients with newly diagnosed NTSCI on their first admission during the study period were included. Crude incidence was calculated using the annual number of NTSCI cases divided by the mid-year population estimates. Age-specific incidence was calculated by dividing the number of cases in 10-year age groups by the total number of individuals in that age group. Age-adjusted incidence was calculated using direct standardization. Annual percentage changes were calculated using Joinpoint regression analysis. The Cochrane-Armitage trend test was conducted to examine the trends of NTSCI incidence according to the types or etiologies of NTSCI.

RESULTS

The age-adjusted incidence of NTSCI increased continuously from 24.11 per million in 2007 to 39.83 per million in 2020, with a significant annual percentage change (4.93%, P < 0.05). The age-specific incidence for those in their 70s and 80s or older was the highest and rapidly increased from 2007 to 2020. According to the types of paralysis in NTSCI, the proportion of tetraplegia decreased, whereas those of paraplegia and cauda equina increased significantly from 2007 to 2020. The proportion of degenerative diseases was the largest among all etiologies and increased significantly during the study period.

CONCLUSION

The annual incidence of NTSCI in Korea is increasing significantly, particularly among older adults. As Korea is one of the countries with most rapidly aging population in the world, these results have significant implications, indicating that preventive strategies and sufficient rehabilitation medical services are warranted for the population of older adults.

Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea

BACKGROUND

To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasi-national databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI).

METHODS

We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane-Armitage trend test was performed according to the injured body region.

RESULTS

In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = - 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases.

CONCLUSIONS

The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

Fact Sheet of Amputee 10-Year Trends in Korea: From 2011 to 2020

This fact sheet was used to analyze the trends in the number of amputees within the population and changes in their health-related behaviors since 2011. Data from the National Survey of Disabled Persons in Korea from 2011 to 2020 were used in this study. The cases of amputation among people with disabilities have increased. Although there were more upper extremity amputations than lower extremity amputations, as amputations below the wrist account for a greater proportion in South Korea than in other countries, the number of upper extremity amputations decreased and lower extremity amputations increased. The most common cause of amputation is accidents, followed by diseases and congenital anomalies. The majority of the amputees were male; however, the number of females showed a gradual increase, and the average age also increased. The proportion of amputated patients with chronic diseases, such as diabetes and hypertension, is increasing, and medical services are relatively limited. In this review study, through the 10-year trend change in the prevalence of amputee, it was possible to infer the impact of personal, social, and environmental changes. Based on these amputee statistics, it is expected that they can be used to plan health and medical policies for the disabled.

Functional improvement by body-powered 3D-printed prosthesis in patients with finger amputation: Two case reports

RATIONALE

The most common upper limb amputations are finger amputations, resulting in functional limitations that lead to problems with activities of daily living or job loss. For many years, prosthetic options for finger amputations have been limited to passive prostheses. In many countries including South Korea, body-powered finger prostheses have rarely been prescribed due to high cost, lack of experience of physicians and prosthetists, low interest and no coverage by insurance benefits. We report 2 cases of work-related finger amputations in patients who received body-powered 3D-printed finger prostheses.

PATIENT CONCERNS AND DIAGNOSIS

Patient 1 was a 25-year-old woman with second and third finger amputations at the proximal interphalangeal level. Patient 2 was a 26-year-old man who sustained a second finger amputation at proximal interphalangeal level.

INTERVENTIONS

We created body-powered 3D-printed finger prostheses that mimicked distal interphalangeal joint motion through patient-driven metacarpophalangeal joint motion using a string connected to a wrist strap and a linkage system. The source code "Knick Finger" was downloaded from e-NABLE.

OUTCOMES

After 1 month of prosthesis training, both patients were satisfied with the prostheses and showed improved performance in patient-derived goals of cooking (patient 1) and typing on a computer (patient 2).

LESSONS

Over the past decade, significant advances have been made in 3D-printed prosthetics owing to their light weight, low cost, on-site fabrication, and easy customization. Although there are still several limitations in the general application of 3D-printed finger prostheses, our study suggests that for patients with finger amputations, body-powered 3D-printed finger prostheses have high potential as an additional prosthetic option to the existing passive cosmetic prostheses.

Satisfying medical and rehabilitation needs positively influences returning to work after a work-related injury: an analysis of national panel data from 2018 to 2019

Background

This study examined how meeting the medical needs of injured workers after initial treatment may affect their return to work, using data from the Panel Study of Workers’ Compensation Insurance.

Methods

This study was designed as a longitudinal study, which used data from the second-year, follow-up survey conducted in the secondary cohort of the Panel Study of Workers’ Compensation Insurance. The odds ratio (OR) and 95% confidence interval were estimated through binomial and multinomial logistic regression analyses to examine the effects of unmet medical needs on workers’ return to original work and return to work overall (including reemployment).

Results

The returned to original work OR of workers whose rehabilitation needs were met was 1.35 (1.12–1.63) while the return to work OR was 1.20 (1.03–1.41). The returned to original work OR of workers whose medical needs were met was 1.64 (1.18–2.27) while the return to work OR was 1.39 (1.07–1.80). In terms of disability rating, the return to work ORs of workers with mild disabilities whose medical/rehabilitation needs were not met and those of workers without disabilities were 1.71 (1.17–2.49) and 1.97 (1.27–3.08), respectively. In the case of regular/temporary workers, the returned-to-work ORs of workers whose medical/rehabilitation needs were not met were 1.54 (1.12–2.13) and 1.27 (1.03–1.56), respectively.

Conclusions

For workers who sustained work-related injuries, providing medical accessibility and meeting rehabilitation needs were found to be important predictors of return to work after initial treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12064-1.

Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018

BACKGROUND

Detailed information regarding workers who experience an amputation in the workplace over the last decade is limited. To better understand the financial and functional impact of a work-related amputation, this study quantifies the incidence of work-related amputations in the California workforce from 2007 to 2018 as well as the relationship between medical costs and lost workdays as a function of amputation level.

METHODS

Workers' compensation claims data from California spanning the years 2007 to 2018 were evaluated to describe trends in amputation incidence (N = 16 931). Quartile values for medical costs, indemnity costs, and lost workdays were reported as a function of amputation level. Correlations were performed between medical costs and lost workdays to examine their relationship.

RESULTS

The average incidence from 2007 to 2018 was 8.9 (95% CI 8.5, 9.4) amputations per 100 000 workers. There was a significant spike in amputations in 2008. Partial-hand amputations were the most common with 73.3 (95% CI 69.2, 77.7) cases per 1 000 000 workers, and the industry with the highest incidence was construction with 26.0 (95% CI 22.4, 30.0) cases per 100 000 workers. Overall, medical costs were moderately correlated with lost workdays (Spearman's rho = 0.51), and that level of correlation remained relatively consistent across all levels of amputation (Spearman's rho = 0.48-0.62).

CONCLUSIONS

Amputations represent high medical costs and number of lost workdays. Considering the type of amputation and the industry the injury occurred in is important in order to work toward returning this population to work. Our results present the status of amputations in the California workplace and establish a basis for using medical costs to infer lost work productivity for this population.

Clinical outcome of staged surgery after primary amputation for mangled extremity

INTRODUCTION

Amputation for a mangled extremity is an effective and reliable life-saving treatment method, which requires a relatively shorter duration for treatment than limb salvage. However, only a few studies have focused on treatment with amputation. Herein, we report good clinical outcomes achieved through staged surgery performed after amputation.

MATERIALS AND METHODS

This study included 47 patients (38 men, 9 women; average age, 52.4 years) diagnosed with mangled extremity, who underwent primary amputation between March 2014 and January 2019. The patients were divided into the initial closure (IC) groups (including 26 patients who underwent IC after amputation) and staged surgery (SS) (including 21 patients who underwent SS after amputation) groups. The presence of complications including necrosis and infection, consequent additional surgery, duration of hospitalization and expense for treatment, and functional scores of upper and lower extremities were assessed.

RESULTS

No specific postoperative complication was found in the SS group. However, additional surgeries were performed in the IC group because of complications including three cases of infection and two cases of necrosis. The differences between the hospitalization period, treatment cost, and functional examination conducted 1 year after surgery of the two groups were not statistically significant. The patients in the IC group who underwent additional surgery were hospitalized for a longer period and presented with lower functional scores due to delayed rehabilitation.

CONCLUSION

Staged surgery is a definitive and safe treatment option that can effectively reduce complications including infection and necrosis in patients with mangled extremity.

Trends in burden of work-related upper limb amputation in South Korea, 2004-2013: a nationwide retrospective cohort study

OBJECTIVES

This study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend.

DESIGN

Ecological study.

SETTING

National level data in Korea between 2004 and 2013.

PARTICIPANTS

49 535 subjects who claimed Korea industrial accident compensation insurance due to upper limb amputation.

MAIN OUTCOME MEASURES

The disability-adjusted life years (DALYs) were calculated by sex, age and the site of amputation using annual incidence.

RESULTS

The burden of work-related upper limb amputations in Korea reached its peak in 2007 and decreased thereafter. Males showed a higher burden of disease. Finger amputations showed a decreasing trend from 2007, whereas arm amputations continued to show an increasing trend. An increasing trend was found among participants older than 50 years.

CONCLUSIONS

The decrease in the burden of finger amputations may be attributable to the lower incidence as a result of policy efforts. The increase in the burden of arm amputations was particularly noticeable among the elderly population over 50 years old. This could be attributable to the high proportion of the elderly population working in the manufacturing sector and the lack of policy efforts regarding major amputations in Korea. Future regulatory efforts are needed to prevent amputations.